KYLE WAGNER – Chiropractor, NPI 1104318310

KYLE WAGNER is a healthcare provider. based in Covington, Washington. specializing in CHIROPRACTIC. They hold a License No. CH60849715 (WA). The NPI Number for KYLE WAGNER is 1104318310

Main info

Male
8 Years Of Experience
Accepts Medicare Assignment
Name
KYLE WAGNER
NPI
1104318310
Phone
Not provided
Address
15610 SE 272ND ST BLDG A
Enumeration Date
4 June 2018
Last Update Date
25 March 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2536382424
Graduation Year
2018 (8 years ago)
PAC ID
0244575181
Group Practice PAC ID
0648262428
Professional Enrollment ID
I20181220000993
Address ID
WA980424416CO15610STXX402
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness75
Years active:8State licenses:1Digital endpointsOther names

1,415 CHIROPRACTIC in WA

Provider Addresses for KYLE WAGNER

  • 15610 SE 272ND ST BLDG A

    COVINGTON, WA 980424416

    Phone:

    Type: Mailing

  • Southeast Kent Kangley Road, Seven Oaks East, Kent, King County, Washington, 98030, United States

    KENT, WA 98030

    Phone:

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2018-12-20

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20181220000993IChiropracticWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98042)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0648262428View full group profile
NameSpecialtyState
C H I R O P R A C T I CWA
C H I R O P R A C T I CWA
C H I R O P R A C T I CWA

Reviews

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Frequently asked questions

What federal number belongs to KYLE WAGNER?
The federal identifier for KYLE WAGNER is NPI 1104318310.
Is KYLE WAGNER active in the national directory?
KYLE WAGNER's public NPI profile is in an active state.
What kind of provider is KYLE WAGNER?
The page reflects Chiropractor for KYLE WAGNER. Clinical services aligned with this taxonomy classification.
Where is KYLE WAGNER's primary listing?
We display Covington, Washington because that is what the record indicates for KYLE WAGNER.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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